Health

10/24/2011

The topic of immunization is often controversial – but in Malawi, it can be deadly as parents refuse their children access to vaccines.

Two months ago, the online publication, Malawi Voice, reported that 131 children from Nsanje, Malawi’s most southern district were vaccinated at gunpoint.

These families had originally fled to Mozambique to “protect” their children from the anti-measles vaccination, but when they returned home, medical officials and police tracked down the children and forcefully vaccinated them.

It was reported that The Bill and Melinda Gates Foundation was behind the involuntary vaccinations. The foundation has been launching extensive campaigns to make sure all children are vaccinated against deadly diseases. When it comes to vaccines, Melinda Gates called Malawi one of the few countries “on track to reach the UN Millennium Development Goals.”

When contacted, the Gates Foundation and its partners in Malawi were unavailable for an interview.

In Malawi, the UN, NGOs and the Malawian Ministry of Health work together to ensure that all children are given shots for tuberculosis, polio, hepatitis and measles, as well as vitamins. The Health Ministry is currently carrying out a mass vaccination campaign, targeting six million vulnerable children under the age of 15 across Malawi.

“It is a requirement that all children are vaccinated, but it’s difficult to trace to see if a child has been vaccinated,” says David Chimwaza, a clinical officer at Queen Elizabeth Central Hospital in Blantyre.

Measles is the most common disease outbreak in Malawi.

Worldwide, 164,000 people, mostly children under the age of 5, die from measles. Even though effective immunization costs less than $1 U.S. and has been available for 40 years.Furthermore, each year more than 1.7 million children die of vaccine preventable diseases, according to WHO.

“During an outbreak everyone has to be vaccinated,” explains Chimwaza. “Officials will go into homes to inspect children to check if they were vaccinated.”

However, in rural communities this can prove difficult without proper record keeping and lack of resources.

Similarly, vaccinations can be controversial in Canada, but for different reasons.

Some Canadian parents believe that the measles, mumps, rubella (MMR) vaccine can be linked to autism or sudden infant death syndrome (SIDS). Although, most doctors and scientists agree the benefits of immunizations that protect against infectious diseases outweigh the rare side effects of vaccines.

In addition to health concerns, some Malawian families are against vaccinations and Western medicine because their religion forbids it, such as the Seventh Day Apostolic Church. Members of the Seventh Day Apostolic Church who do receive medical care are excommunicated from the church.

A Malawian father, who follows the Seventh Day Apostolic faith, was sentenced to two years in prison after refusing to let his three children receive the measles vaccine due to his religious belief. Police believe that one of his children died from the illness.

In nearby Zimbabwe, the World Health Organization (WHO) issued a bulletin in 2009 stating that the majority of unvaccinated children belong to apostolic faith sects, 45 per cent and 23 per cent belong to the Pentecostal Church.

Muslim fundamentalists are also against immunization programs because vaccines can contain animals that have not been killed in accordance with ritual or can contain alcohol.

In some cases Muslim fundamentalists believe vaccines are used by the West to poison or sterilize followers of Islam.

“Usually because of religion, children do not receive vaccines. They have the idea that if you are sick God will help you - you don’t have to take drugs and medicines,” says Chimwaza.

As for the children who were vaccinated at gunpoint,he explains that both the measles outbreak and the need for its immediate containment were the cause for such an extreme response.

“The police had to vaccinate at gunpoint,” he says.“I think it was the first time that has happened.”

10/14/2011

On Aug. 4 a teenage girl walked into Ghana’s Tamale Teaching Hospital bleeding from her uterus. She had taken Cytotec, a drug meant for stomach ulcers but can induce abortion. Three hours later she bled to death.

On average rouhgly 40 women a month have been admitted to the hospital with complications from at-home abortions. Their methods are numerous – some have inserted concoctions into themselves, others have used broken bottles to try and remove the fetus or some ingest drugs.

Abortion is a leading cause of maternal death in Ghana, reports say.

Safia Zakaria is the principal nurse in the gynaecology ward in the predominantly Muslim capital. Though at first she often advises women to keep the child, she has chosen to loosely interpret Ghanaian law and performs abortions with NGO-donated equipment.

“Me in particular, I swore never even to do it, but there are instances... just to save life," she said.

In Ghana abortion is a criminal offence with practitioners facing a penalty of up to five years in prison. Many are afraid to seek safe abortion services for fear they will be stigmatized.

The lack of clarity in government policies is a reflection of the ongoing struggle in Ghanaian society – a race towards modernity running up against limited resources and deeply traditional beliefs.

Dr. Husein Zakaria is executive director of CODYAC, an Islamic youth centre in Tamale that seeks to address key issues affecting the lives of young people. He conceded that the young women showing up at TTH need medical care, but does not support offering them abortion services.

“The kind of legalization you are talking about is where everybody can walk to the doctor and say 'I’m pregnant I don’t want it, please just quash it'. I think that system is not the best for people like us,” he said.

In the meantime, to curb the growing problem of teenage pregnancy his office encourages abstinence.

09/21/2011

A mental health patient undergoing a medical check-up. Epilepsy, depression, schizophrenia and bipolar disorders are some of the top mental afflictions in Malawi. Photo by Blantyre News Limited.

By Elena Sosa Lerin and Lucas Bottoman

According to the World Health Organization (WHO), mental health problems are already the fourth leading cause of the global health burden, representing a third of all years of healthy life lost to disability among adults.

By 2020, they will rank second, behind heart disease.

In Africa, regional WHO studies show that mental health issues such as epilepsy, depression, psychosis, mental retardation, substance abuse, and other psychotic disorders, are among the top ten causes of disability in the region.

But in Malawi, one of the poorest countries in the world, where health policies and development goals are primarily centered on the prevention of HIV and AIDS, the reduction of maternal mortality, tuberculosis, and malaria, mental healthcare is - at best - an afterthought.

Case in point, the Ministry of Health has no solid data on the nature and the extent of those suffering mental illness.

Its National Mental Health Policy Plan admits that in the absence of research on mental health patients, it has had to rely on studies done in neighbouring countries.

Based on these studies, health officials estimate that at least 10 per cent of Malawi’s 15 million people are affected by a mental health problem, also meaning that mental health afflictions are as common as infectious diseases.

And yet, given these dire statistics, the Ministry of Health’s Strategic Plan for 2011-2016 recognizes that the government’s budget for the health sector is “inadequate.”

Health places third in budgetary allocation, (at 10.2 per cent) after education (13.7 per cent) and agriculture (18.9 per cent).

Less than two percent of the national health budget is spent on mental care.

In 2007 and 2009, respectively, Malawi signed and ratified the United Nations Convention on the Rights of Persons with Disabilities and its Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care.

Among the guiding principles of this Convention are accessibility to facilities and services, the right to health, as well as habilitation and rehabilitation services and programs.

The Malawian Constitution addresses the right to development, declaring that the State commits itself to “take all necessary measures” to guarantee “access to basic resources, […and] health services.”

But with such a tight budget, intentions can only go so far.

Mental patients have to deal with public mental healthcare institutions that suffer chronic shortages of essential drugs, inadequate if not, deteriorating facilities, insufficient and overworked nurses and doctors, and no access to counseling.

For instance, the psychiatric section of the Queen Elizabeth Central Hospital (QECH), the largest hospital in the city of Blantyre, has been out of essential drugs, (like Chlorpromazine and Modecate, which are used in the treatment of conditions such as schizophrenia, psychoses and manic episodes) for over a year, while the one at the Bwaila Hospital in the capital, Lilongwe, has lacked medication for 10 months.

Based on hospital records, six out of 10 patients are relapsing due to the lack of drugs at QECH.

“There’s no hope for many patients,” says one of the psychiatric nurses from QECH. “It is a very sad situation to see – and we can’t do much about it.”

The little the nurses can do is to use substitute drugs if possible. But sometimes they have to turn patients away if there are not adequate drugs to treat their specific needs.

“We feel very sorry to tell the patients who have walked for many hours to get their medication that we don’t have any,” says another nurse from Bwaila Hospital.

As if the lack of essential drugs were not enough, there is also the issue of the scarcity of mental healthcare workers.

For instance, QECH has just one psychiatrist and 18 nurses to attend an average of 2700 patients a year. Bwaila Hospital does not even have a psychiatrist. It is entirely run by five nurses who attend about 200 patients every day.

Two years ago, Dr. Rob Stewart, the head of the psychiatric unit at QECH decided to shut down admissions of patients because the rooms lacked windows and toilets.

One of the nurses from QECH, when asked what improvements she’d like to see in the mental healthcare system, said having a computer would make a big difference, as patients’ records are still handwritten and usually get lost or mixed with other papers.

“The only piece of technology we have here is a telephone, “ she says.

05/25/2011

Malawian student Mercy Khowoya says “HIV and AIDS is real – if you can’t abstain then don’t be ashamed to use a condom.” Photo by Katie Lin.

By Katie Lin

“Nyimbo imodzi sachezelela gule.” (One song won’t keep you dancing throughout the night.)

As this Malawian proverb suggests, just one sexual partner won’t satisfy a person for their entire lifetime.

But in a country where approximately 12 per cent of the population is infected with HIV/AIDS and having multiple concurrent relationships is common, only 72 per cent of sexually active men and women are using condoms, says a 2010 health report by the National Statistics Office of Malawi.

An informal survey of management-level professionals in Malawi conducted by a Canadian public health specialist found that 100 per cent of the participants agreed they are “personally at risk for HIV and AIDS.” Yet, less than 10 per cent reported feeling “confident” when purchasing condoms.

While the survey results are not statistically representative, they do indicate that many people are simply too embarrassed to buy condoms and indicates that knowledge doesn’t necessarily inform behavior.

Condoms can be purchased in Malawi for 30 kwacha ($0.19 CAD) for a pack of three.

They can also be found for free at all government hospitals.

So if condoms are indeed so widely available, what’s the excuse for not using them?

For one: “Switi sadyera mpaketi.” (You can’t taste candy if you eat it while it’s still in the wrapper.)

This popular Malawian adage speaks to the belief that the use of a condom will make sex less pleasurable. As Veronica Chikafa, Capacity Building Coordinator at the Malawi Business Coalition Against HIV/AIDS (MBCA) explains many believe “sex was made for there to be no barrier in between.”

Secondly, using a condom is generally viewed as the man’s domain.

“It’s the male who puts [the condom] on,” she says, “so it’s the male who makes the decision.”

Chikafa says that opening up communication between partners is a priority, no matter what the circumstances of their relationship.

However, there remains a gap in sex education which also must be addressed, she maintains.

“I was told that there was a lady who went for family planning and somebody did a condom demonstration using their thumb,” she says. “[She] put the condom on her thumb and got pregnant, of course.”

Dickson Chidumu, Head of Operations at the Malawi Union of Savings and Credit Cooperatives (MUSCCO) and leader of a campaign called “Be a Hero. Use a Condom,” acknowledges that such misunderstandings are not only a result of poor sex education, but also not wanting to talk candidly about sex.

“To some people, this language is considered obscene language. But they need the facts. We are running away from speaking about the facts.”

Through the continued efforts of organizations such as MUSCCO and MBCA, and of course with time, Chidumu is hopeful that cultural attitudes towards sex and sexual practices will change.

For the fact remains that you just never know:

“Wokaona nyanja anakaona ndi mvuu yomwe.” (When you go to the lake, you might see hippos.)

In other words, you may think you know your partner’s status, but there exists the possibility that you may encounter the unexpected – so it’s best to be prepared.

05/09/2011

Nortey Quaynor sits at his station in Accra’s United Biscuits factory. His hands move swiftly sealing bags of freshly baked cookies with Barack Obama’s face pressed into them. Large machines fill the warehouse with a deafening drone while the sweet aroma of fresh baking wafts in the air. Nortey remains undistracted by the hundreds of people working around him. It’s his seventh month at the biscuit factory and the other workers no longer look at him like he’s different.

Nortey has lived with autism for 28 years, and for the first time in his life, he has a job. He doesn’t know exactly who President Obama is, but he does understand that he has a task to do: seal biscuit packages. His caregiver, Abiku Grant, who works for the Autistic Awareness Care and Training Centre (AACT) in Accra, stands off to the side exhibiting a proud grin.

AACT is the only centre in Ghana that works specifically with autistic people, and the high demand for support only allows them to care for people up to 25 years old.

Grant says the training program at the biscuit factory was established to teach autistic people skills they can use to find work once they leave the centre. However, setting the program up wasn’t easy.

“There is so much stigma surrounding autism and disabilities in Ghana, people look at them and think that they are mad,” says Grant. “They don’t think they can be taught the skills to work.”

In light of April being autism awareness month, a conference was recently held in Accra to bring together the West African autism community for the first time.

Dr. Emmanuel Badoe, Director of the Neurology Developmental Clinic at the Korle Bu teaching hospital in Accra, was a presenter at the conference. He says there are no statistics on how many people have autism in West Africa and there are only a handful of professionals who work with developmental disorders in the region. Beyond that, he notes a lack of information for Ghanaian families about autism; many people don’t even know the disorder exists.

This lack of public awareness has made it difficult for people with autism to be accepted into regular society, let alone gain employment.

“This is a real way forward,” says Dr. Emmanuel Badoe, speaking about the work program. “People with disabilities need to be integrated back into society. This is a great thing for our country.”

Nortey was the first member of AACT to be placed in the biscuit factory, where six other autistic men and women are also employed. Nortey works in a spaghetti factory too, and AACT is hoping more companies open their doors to autistic workers.

Thorugh his work, Nortey is slowly changing the perception of autism in Ghana. When his mother, Serwah Quaynor, founded AACT it was out of a need that was not being filled by other facilities. She knew Nortey could not be the only one with autism in Ghana and opened the centre, but never expected to get to a point where her son could be employed.

“People are finally realizing what autism is,” says Quaynor. “Now the workers in the factories look at Nortey like he is a normal person.”

Nortey will continue to do his part in changing the public view towards people with autism, one Obama biscuit package at a time. Yes he can.

Africa Without Maps

There's so much more to Africa than predictable headlines about war, famine and AIDS. From Ghanaian beauty pageants to music in Malawi, Africa Without Maps provides a rare glimpse of life in Africa from Journalists for Human Rights interns on the ground.

Funding for the jhr bloggers is provided by the Government of Canada's Youth International Internship Program.

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